Kaiser Permanente Medial Group, San Diego, California, USA.
J Dev Behav Pediatr. 2009 Oct;30(5):474-7. doi: 10.1097/DBP.0b013e3181bb7578.
Sonia's mother was concerned about her 9-year old daughter's aggression, defiant behavior, and distractibility. When she was 4-years, she kicked her bother and he lost a tooth as a result of the trauma. At this time, her pediatrician was concerned about hyperactivity, impulsivity, and defiance of authority and recommended a psychological evaluation. Sonia's father refused an evaluation and responded by physically abusing his wife while demanding a transfer to a new physician. Sonia's mother left her husband at this time and moved away with Sonia. Spousal abuse occurred frequently before the separation, and Sonia may have been physically abused as well.Currently, Sonia is in third grade where she is underperforming in many areas. She enjoys drawing and reading, but struggles to sit quietly and stay on task. Her teacher reports frequent vocal and physical disruptions. Homework takes an inordinate amount of time to complete. She does not have a sustained friendship; her mother feels that this is because other kids do not like being bossed by Sonia. Her mother is concerned about Sonia's behavior especially the unremorseful disruptive behavior toward her younger brother and grandmother.Sonia was born after an uneventful full-term pregnancy without evidence of maternal smoking, drugs, alcohol, or medications. Motor and social developmental milestones were achieved at the appropriate time. Language milestones were achieved early; her mother recalls that Sonia learned to read at the age of 3 years.Sonia's medical history is significant for obesity, seasonal allergic rhinitis, and delayed sleep onset with prolonged awakenings associated with nightmares. Her mother reports that Sonia "worries about everything," including thoughts that her brother will turn into a monster. When an argument occurs at home, she "gets scared," bites her nails, and cries. Sonia currently lives with her mother, 2 younger brothers, step-father, and grandparents. Family history is significant for drug abuse by her father and mental illness in the father's family.While conducting an interview with her mother, Sonia was asked to draw a picture of her family. Instead, she illustrated a book detailing her past experience in words accompanying each drawing. She described how she watched her father physically abuse her mother and her persistent fear of danger when conflict occurred at home. Although spelling was poor, her vocabulary, sequencing, and illustrations demonstrated above age-level skills for written expression and drawing. Examples of the writing that accompanied the drawings include: "I hate when my parents fight. I get scared and feel sick to my tummy like I want to throw up. I just hate that feeling!" "My mom told me she had a 'boyfriend.' These words were the most horrible I ever heard. Soon a nightmare began. Nightmares make me very, very scared."
索尼娅的母亲对她 9 岁女儿的攻击性、挑衅行为和注意力不集中感到担忧。她 4 岁时踢了她的哥哥，导致哥哥的一颗牙齿受伤。当时，她的儿科医生担心她过度活跃、冲动和不服从权威，并建议进行心理评估。索尼娅的父亲拒绝了评估，并对他的妻子进行了身体虐待，同时要求转介给新医生。索尼娅的母亲此时离开了她的丈夫，并带着索尼娅搬了出去。在分居前，夫妻之间经常发生虐待行为，索尼娅也可能遭受过身体虐待。
目前，索尼娅上三年级，她在很多方面表现不佳。她喜欢画画和阅读，但很难安静地坐着并完成任务。她的老师报告说她经常发出声音和身体上的干扰。完成家庭作业需要很长时间。她没有持久的友谊；她的母亲认为这是因为其他孩子不喜欢被索尼娅指挥。她的母亲对索尼娅的行为感到担忧，尤其是她对弟弟和祖母毫不悔改的破坏性行为。
索尼娅出生于足月，没有母亲吸烟、吸毒、饮酒或服用药物的迹象。运动和社会发展的里程碑都在适当的时间达到。语言里程碑也很早就达到了；她的母亲回忆说，索尼娅在 3 岁时就学会了阅读。
索尼娅的病史包括肥胖、季节性过敏性鼻炎和入睡延迟，伴有噩梦引起的长时间觉醒。她的母亲报告说，索尼娅“担心一切”，包括她的哥哥会变成怪物的想法。当家里发生争吵时，她“会感到害怕”，咬指甲，哭泣。索尼娅现在与她的母亲、两个弟弟、继父和祖父母住在一起。家族史显示，她的父亲有滥用药物的问题，父亲的家族中有精神病史。
在对她的母亲进行访谈时，索尼娅被要求画一幅她的家庭的画。然而，她画了一本详细描述她过去经历的书，每幅画都配有文字。她描述了她如何目睹父亲对母亲进行身体虐待，以及当家里发生冲突时她持续的危险感。尽管拼写很差，但她的词汇量、排序和插图展示了高于年龄水平的写作和绘画技能。画伴随的文字示例包括：“我讨厌父母吵架。我感到害怕，肚子不舒服，就像要吐了一样。我就是讨厌那种感觉！”“我妈妈告诉我她有了一个‘男朋友’。这些话是我听过的最可怕的。噩梦从此开始。噩梦让我非常非常害怕！”
